Evidence-Based Medicine for Pharmacists in Patient-Centered Medical Home
Slide Presentation in Text Format

Monday, December 13, 2010

11:00-12:30pm, ET

On the top of the slide are the logos for the Department of Health and Human Services and the Agency for Healthcare Research and Quality (AHRQ).

Slide 2

Development and Support

This Web conference was developed by the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care Program with assistance from the American Pharmacists Association.

On the bottom of the slide is the logo for the Effective Health Care Program and the American Pharmacists Association.

Slide 3

Accreditation and CPE Information

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE). This Web conference, Evidence-Based Medicine for Pharmacists in the Patient-Centered Medical Home, ACPE #202-999-10-270-L04-P, is approved for 1.5 hours of CPE credit (0.15 CEUs).

To obtain CPE credit for this Web conference, participants must participate in the entire Web conference and complete the online evaluation by December, 27, 2010. A voucher code and further instructions will be provided during the Web conference. In order to complete the online activity evaluation form, participants will need to have a valid Pharmacist.com user name and password. A Statement of Credit will be automatically generated upon achieving these requirements.

Slide 4

Accreditation and CPE Information

Target Audience: Pharmacists

ACPE Activity Type: Knowledge-based

Learning Level: Level 1

Slide 5

Learning Objectives

After participating in this Web conference, pharmacists will be able to:

Define the tenets of the patient-centered medical home and AHRQ’s role.

Describe the various patient-centered medical home models and list the numerous roles for pharmacists in a PCMH.

Discuss successful implementation strategies and potential barriers to the PCMH.

Recognize the Effective Health Care Program as an evidence-based resource for pharmacists.

Slide 8

Scott R. Smith, Ph.D., R.Ph., M.S.P.H., How AHRQ’s EHC Program can support the Pharmacist’s Role in the PCMH
Director of Pharmaceutical Outcomes Research Programs
Center for Outcomes and Evidence
AHRQ
Rockville, MD

Images of Dr. Willey, and Dr. Smith are on the left side of the slide next to their name and title.

Slide 13

Slide 14

The Medical Home

AHRQ believes that the primary care medical home, also referred to as the patient-centered medical home (PCMH), advanced primary care, and the healthcare home, is a promising model for transforming the organization and delivery of primary care.

Slide 15

The Medical Home

A medical home not simply a place but a model of primary care that delivers care that is:

Patient-centered

Comprehensive

Coordinated

Accessible, and

Continuously improved through a systems-based approach to quality and safety

Slide 16

AHRQ’s Definition of the Medical Home

Key components

Patient-centered: Relationship-based with an orientation toward the whole person

Comprehensive Care: Team-based care that includes providers from multiple disciplines, including pharmacy

Coordinated Care: Clear, open communication and transfers of accountability, especially during care transitions

Slide 30

Slide 31

PSPC Teams are Transforming and Improving Quality Delivery Systems

This slide is a visual of how PSPC is working to improve the overall delivery system. PSPC focuses on comprehensive primary care including transitions of care. The PSPC aims to integrate clinical pharmacy services into the patient-centered health home.

On the left there is a traditional model which indicates that is not powerful enough to significantly improve outcomes, particularly for complex patients. In an ideal world everyone would have a primary care physician.

Slide 32

Models for Medical Home “Doc alone with an Rx pad”

This slide shows the traditional model of care that is available. The traditional model only covers basic episodic care, which leads to status quo outcomes.

Slide 33

Models for the Medical Home Systems/Teams for Better Outcomes

This slide shows the advanced model. This model illustrates that there needs to be a way to minimize the old standard of care, which is only visiting the doctor in his or her office. The advance model shows that there are three levels that need to work together to result in better outcomes. These three levels work to close the outcomes gap.

Doctors office ó Basic Care, Episodic

Expanded Medical Home ó Preventive Planned Care

Comprehensive Health Home: Community Health Centersó Disparity

Slide 34

The “3T’s” Road Map to Transform US Health CareThe “How” of High-Quality Care

This is a diagram of the three Ts of transforming healthcare.

Slide 35

Acquiring and Advancing Knowledge to Achieve Better Outcomes

This is another diagram of the three Ts of transforming healthcare. One example illustrates an ace inhibitor. T1 represents the basic biomedical research; someone discovers the chemical compound that can inhibit the angiotensin converting enzyme. However, without the next step one will not be able to impact public health. T2 is in the middle and has an image of a funnel that represents the clinical research trials that will eventually be marketed. T3 shows that despite the clinical research, there is a huge backlog in systems-based performance improvement, which is leading to patients falling through the cracks. This is represented by the boat neck on the diagram. Currently, PSPC is at the boat neck. The average patient in the PSPC population takes at least eight prescription drugs and has five chronic conditions, and sees multiple providers.

Slide 36

Health Status Breakthroughs in High-Risk Patient Populations

The PSPC high-risk patient population is characterized by:

8 drugs per patient

5 chronic conditions per patient

3 providers per patient

The soundtrack for our patient’s health care stories?: Scary Music30% of PSPC teams’ total patients are in this high-risk population

Slide 37

Health Status Breakthroughs for Multiple Populations of Focus (PoFs)

On this slide there is a pie chart showing the distribution of Teams by PoF. The pie chart is divided into Anticoag (15%), Asthma (8%), BP (5%), Diabetes (54%), HIV/AIDS (13%), LDL (5%).

For each of these POFs, teams are working to bring patients from health status out of control to under control.

Slide 38

Imagine a future when:

Patients

Are in proactive, comprehensive medical homes

Receive indicated planned/preventive care

Understand what each med is intended to do

Safely use indicated Rx to achieve those goals

Are in a world class community of practice Health Professionals

Work collaboratively, with joy

PSPC is doing this, and WILL BLOW THE DOORSOFF STAUS QUO!

Slide 39

A Map on the Road to Improvement

“Change Package”

Details the leading practices that together address the Aim and Goals of the improvement process.

Developed by harvesting lessons from high performing organizations that have achieved outstanding results.

Reviewed and vetted by a panel of national experts.

Serves as the catalogue of leading practices that teams adapt and use to accelerate the improvement process.

Slide 40

The PSPC Change package is organized into five strategies to achieve results

This slide has a pyramid with the top of the pyramid labeled as Patient Centered Care, the middle portion labeled Safe Medication Uses System, and the bottom portion labeled Integrated Care Delivery. The free space on the left side of the pyramid is labeled Leadership Commitment, and the free space on the right side of the pyramid is labeled Measurable Improvement.

Sets priorities and coordinates with existing agencies that support patient-centered outcomes research

Prohibits findings to be construed as mandates on practice guidelines or coverage decisions and contains patient safeguards

On the right side of the slide there is an image of an office building.

Slide 75

Understanding Uncertainty About Decisions

This slide has a diagram which is taken from The New England Journal of Medicine. Panel A represents how everyone is trained to think about interventions. The author’s argue that interventions are made to depict thresholds and a “one-size-fits-all” approach; however, there’s a threshold which the net benefits outweigh the risk. If one is able to see that threshold through lab tests or some kind of other clinical diagnostic measure, then they can automatically recommend care. Below certain thresholds, care is often discouraged. The second part of the diagram shows model B which has a large gray area that represents small benefit or uncertain net benefit, labeled Discretionary Care. This area asks clinicians to defer to patients about their preferences about care, and whether a certain benefit is important to them. The main purpose of this diagram is to recognize that different decisions have different evidentiary needs. This is what the Effective Health Care Program works to address.